__________________________________________________________________________________________________________________________________________________________________________________________________________ •
Dale -rg-, 	Aircraft Make and Model 	Aircraft Identification Mark 	Points of Departure & Arrival 	Mites Flown 	Flight No. 	Remarks, Procedures, Maneuvers, Endorsements 	Number of Landings 	Aircraft Category...
From 	--I To
(1).:a ewe- 	GA-Erc-4 	k...ct Lgat
ci 	G -\\510 	Nctocizcz 	Lc. q
2-- 	It 	1 t 	VO 	1-6-4- 0 	15c5 	--,‘ 6. (.7. L- P aspc6,,, 	\ / 	1 	C
.1 	3
\--i 	0--121-31 	(octbY,.-se 	LC G4 	CO): 	-225 	ei.-.10es.:0-co,J (-:+tol'A. 19P.t,C,hrr ti-rpato) 	1./k 	a 	9
2..G
CLic 	LF.-e35 	2--) 	"sc.--ic-d\'` 	/3' 	1-1 	(A
i
23 	t l 	% L 	LC.' r 0 	L t iv\ L 	OZ6 	:1-&-'/G- PI, 	1 / \ 	I 	2-
273 	I, 	\ t 	1.--1v\ L., 	Lif_ FR 	.251 	(:„/66atigirt.,. y) vvAi2 06 	\ /1 	(.4
9
2:t...\ 	\ ( 	\ 	L-./•'\ L. 	g_-:C.-CAro 	3 	-.1-c-, 6-m, 	N 	1
0.1. 	t t 	1 , 	LC.,-(,\x) 	\'J 	32_ 	.----/C,./''') 	i 	cl
\17 pi 	90r 	.3-3. 	a 4., 6-wc-.11-put--1,tu 6-.4.4t, :sce.-:L. P,65)tc,v,..._\ 	/ 	2_ 	S-
i
W.- 	1( r 	___ ‘ ( 	rbr 	s 	sit 	"/ 	i /
1 	s--- 	----V-
<6 	I t 	t 	'f' 	i) ' -17
cl 	t ( 	1 ( 01 	V. 	- .7--Y- 	- 	-2,(-_,- 	at:-.., c.,..fr), Bei \ fe--•
\ /
3 	it. 	It 	IT- -.1- 	\ 4r 'I° 	31 	(3
C.,k/N \-- 	3 % 	1 ....1._ -71 • 1 .4- 3 -, 1 y - 	I 	I
.
\C- 	t • 	1 	C M 9- 	Q 0 C 	'-'3 9 	:5's--. 	)_ 	\
I certify that the statements made by me on this form are true. \ Pilot's S' .ure \\ -. 11/(- (Le-A (1-iititCY11--- 	Page Total 	-Ki 	L-.?
Amount Forward 	04-45fC ck 	<8 4 14 	3 	3 	\ IL 	c;
Total to Data 	6 15 	g Lk Co 	3 	\ IX. 	k
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